Low-Grade Leiomyosarcoma of Inferior Vena Cava
|
|
- Laureen Marsh
- 5 years ago
- Views:
Transcription
1 Case Report Intervention pissn eissn Korean J Radiol 2013;14(2): I Brachytherapy Seeds Implantation for Inoperable Low-Grade Leiomyosarcoma of Inferior Vena Cava Yuliang Li, MD, Yongzheng Wang, MD, Bin Liu, MD, Zheng Li, MD, Wujie Wang, MD All authors: Department of Interventional Therapy, The Second Hospital of Shandong University, Jinan , China A 60-year-old female presented with abdominal pain and tenderness of five-day duration. Contrast enhanced CT showed a mass of cm in size with almost complete obliteration of the inferior vena cava and massive extension to the extravascular space. CT-guided biopsy demonstrated a low-grade leiomyosarcoma. The patient underwent 125 Iodine seeds implantation in two sessions, and another balloon cavoplasty. Abdominal pain and tenderness gradually improved and the patient continues to remain as disease free state for three years after the procedures. Index terms: Leiomyosarcoma; Inferior vena cava; Brachytherapy; Cavoplasty INTRODUCTION Vascular smooth muscle tumors are rare and include a variety of neoplastic lesions characterized by their histological similarity to adult smooth muscle tissue. These tumors are usually benign as with diseases such as leiomyoma, intravascular leiomyomatosis and angioleiomyoma. There is also a very rare malignant formleiomyosarcoma. Vascular leiomyosarcomas arise predominantly in the inferior vena cava (IVC), and less commonly in the pulmonary arteries or veins or other peripheral vessels (1). Surgical resection is considered to be the main treatment for this disease. We present a rare case of leiomyosarcoma in the IVC with Received February 10, 2012; accepted after revision March 7, Corresponding author: Yuliang Li, MD, Department of Interventional Therapy, The Second Hospital of Shandong University, 247# Beiyuan Street, Jinan , China. Tel: (86) Fax: (86) lyl.pro@163.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. massive extension to extravascular space which was treated successfully with iodine 125 ( 125 I) seeds implantation rather than surgery. This was considered as the best option taking account of the risk and the high rate of recurrence. Brachytherapy was planned because of consecutive radioactive effects on the tumor, lower damage to normal tissue and the definite curative effects. Despite our extensive review of English literature, we could not find any similar case of successfully treated IVC leiomyosarcoma. CASE REPORT A 60-year-old woman was admitted to our hospital with abdominal pain over the course ofthe last five days. Tenderness in the right upper abdomen was noted on physical examination. Intravenous contrast enhanced CT scan showed a mass 9 x 6 x 5.5 cm in size with almost complete obliteration of the IVC with a large extravascular component (Fig. 1A, B). The mass was located in the suprarenal IVC with its epicenter outside of the IVC, and presented no extension to the renal vein. Exact diagnosis in this case was uncertain thus biopsy of the mass under CT guidance was performed. Histology revealed diffuse distribution of spindle cells with mild atypia in fibrous 278 Korean J Radiol 14(2), Mar/Apr 2013 kjronline.org
2 125 I Brachytherapy Seeds Implantation for Inoperable Leiomyosarcom of IVC tissue. Immunohistochemical stains for smooth muscle desmin were positive and those for interstitialoma, endothelium and neurogenic tumors, including CD34, CD117, S100, nestin and Alkaline were negative, which were all consistent with the diagnosis of low-grade malignant leiomyosarcoma (Fig. 1C, D). After informed consent from the patient and approval of the Ethics Committee of our hospital, 125 I seeds implantation of the mass by posterior approach under CT guidance was performed. Three days before 125 I seeds implantation, the patient underwent a detailed tumor volume study using CT scans with slice thickness of 5 mm. A B C D E Fig. 1. Tumor, pathology, treatments and follow-up CT. Intravenous contrast enhanced CT of mass. Axial view (A, arterial phase) at level of renal vein demonstrates huge mass (white arrow) involving inferior vena cava and partially surrounding left renal vein. Coronal reconstruction (B, venous phase) shows normal corticomedullary enhancement bilaterally, confirming normal function of both kidneys (white arrow). Histology and immunohistochemistry of leiomyo-sarcoma in inferior vena cava. H&E (C, x 200) stain reveals spindle cells (white arrow). Tumor is positive for desmin (D, x 400, brown) indicating leiomyosarcoma deriving from smooth muscle. E. Precontrast follow-up CT three months after two sessions of 125 I implantation. Tumor size has markedly decreased and disappeared almost completely. Note high density spots of 125 I seeds (white arrow). kjronline.org Korean J Radiol 14(2), Mar/Apr
3 Li et al. A radiation oncologist outlined the gross tumor volume (GTV) and marked areas at risk for subclinical disease on each transverse image. The planning target volume (PTV) included the entire GTV and cm margins. The dose was prescribed as the minimal peripheral dose (MPD) encompassing the PTV. The distribution, MPD of 125 I seeds and dose volume histogram (DVH) were calculated using computerized treatment planning system (RT- RSI, Beijing Atom and High Technique Industries Inc., Beijing, China). Lead protective bucket, vest, apron, spectacles and gloves were used by the operator and the assistants. Puncture region was marked based on the CT image. Following local anesthesia with 0.5% lidocaine and sedation with pethidine hydrochloride and promethazine hydrochloride, eighteen-gauge needles were placed via posterior paraspinal approach or through the space between right kidney and the vertebraes. The procedure included 2-3 steps under CT guidance in a parallel array of 1.0 to 1.5 cm apart, and extended at least cm beyond the GTV. 125 I seeds (Jaco pharmaceuticals CO. LTD, Ningbo, China, t1/2: 59.6 days, F G H Fig. 1. Tumor, pathology, treatments and follow-up CT. Balloon angioplasty for inferior vena cava (IVC) stenosis eight months after 2nd session of 125 I seeds implantation. Inferior vena cavography before angioplasty (F) demonstrates stenosis and partial IVC obstruction, with retroperitoneal collateral circulation (white arrow) in keeping with IVC thrombosis. View after cavoplasty (G) shows almost normal lumen of IVC segment. H. Enhanced follow-up CT of 33 months after 2nd session of 125 I seeds implantation. CT scan reveals disappearance of tumor without significant caval stenosis or thrombosis. 280 Korean J Radiol 14(2), Mar/Apr 2013 kjronline.org
4 125 I Brachytherapy Seeds Implantation for Inoperable Leiomyosarcom of IVC energy level: kev) were implanted using a Jaco applicator and Radiation-proof implanting needles (Hakko trading CO. LTD., Shanghai, China). The space between seeds (center to center) was kept at 1.0 cm. 30 seeds were implanted with an activity of 0.8 mci. The distribution and uniformity of the 125 Iodine seeds in the lesion and drifting seeds analysis was done under the CT scan. The total procedure lasted 60 minutes, and the dose burden of radiation was 10 msv under CT guidance. Abdominal pain of the patient was relieved in one month after the procedure was performed. Three months later, a follow-up CT examination showed that the size of tumor was decreased, although a cold area was noted at the posterior margin. A second 125 I seeds implantation by latero-posterior approach through the lateral space of right kidney under CT guidance was then performed and mci 125 I seeds were introduced into the cold area. After the 2nd session of brachytherapy the course was uneventful and the patient remained in the hospital for 5 days for observation of any unexpected complications. No procedurerelated complications were observed. Three months later, CT examination showed high density 125 I seeds surrounding the IVC and the previous space-occupying mass disappeared (Fig. 1E). Five months after the last CT examination the patient was readmitted with lower abdominal pain and presence of lower leg edema. Inferior vena cavography showed narrowing and partial IVC obstruction at L2-3 level, with retroperitoneal collateral circulation in keeping with IVC thrombosis (Fig. 1F). After anticoagulant and thrombolytic therapy for one week, cavoplasty was performed with balloons of 5 40 mm and mm consecutively. After angioplasty, the diameter of IVC segment was about 20 mm (Fig. 1G). The patient was free of symptoms five days after the procedure. 2.5 mg warfarin per day was used as anticoagulant therapy for the next 3 months. 125 I seeds implantation and balloon cavoplasty worked very well in this patient. At follow-up, the patient was free of symptoms and CT scan showed disappearance of the tumor and no recurrence for 33 months after the 2nd session of brachytherapy, with no thrombosis in the IVC (Fig. 1H). DISCUSSION Vascular smooth muscle tumors are rare, including benign and malignant forms (1). Leiomyosarcomas of vascular origin, the malignant form, arise most frequently in the IVC. It is most commonly detected in women in their sixth decade, and presents with 3 main growth patterns: 62% of the cases demonstrate extraluminal, 5% intraluminal, and 33% extra- and intraluminal growth patterns (2). Leiomyosarcomas of the IVC are classified into 3 groups according to the localization in the IVC. Upper segment involvement extends to the level of the renal veins and lower segment involvesthe infrarenal portion. The percentages of upper, middle, and lower section involvement are 24%, 42%, and 34%, respectively (2). Modern imaging modalities using computed tomography, magnetic resonance imaging, cavography, ultrasound, and positron emission tomography allow for an accurate preoperative diagnosis of tumor extension and resectability. Despite advanced imaging technologies, the final diagnosis is still requires pathological assessment. Histopathology of leiomyosarcoma reveals spindle tumor cells, which are positive for markers of smooth muscle activity including vimentin, muscle actin, alpha-smooth muscle actin, and desmin. Malignancy is indicated by variable cell size and shapes and increased nuclear/cytoplasmic ratio. Since the experiene with this disease is very limited, the optimal management of IVC leiomyosarcoma is unestablished (3). At present aggressive surgical therapy is recommended by most authors. En-bloc resection demands primary tumor extirpation and resection of involved adjacent structures, with or without caval reconstruction (4). Major disadvantage of surgery is the high rate of recurrence. Cho and colleagues reported a mortality rate of approximately 11.11%, and recurrence rate of 44.45% after surgery (5). As for adjuvant therapy, radiation treatment is generally considered beneficial. Preoperative external-beam radiation therapy (EBRT) could facilitate marginally negative resection (6), and postoperative radiation treatment can diminish local recurrence and may improve survival (7). However, EBRT can not avoid normal tissue effectively, and there are difficulties regarding the dose of radiation. In three-dimensional conformal radiotherapy (3D-CRT) high concentration of dose radiation conforms to PTV and sparing normal adjacent tissue is delivered compared with EBRT. This in turn leans to minimal radiation to the surrounding normal tissues is minimal. However, 3D-CRT is a sophisticated technique compared with brachytherapy which is a relative simple technique. The use of postoperative chemotherapy has long been recommended for these types of patients, although evidence kjronline.org Korean J Radiol 14(2), Mar/Apr
5 Li et al. for the efficacy of this treatment is sparse (7). Preoperative chemotherapy has rarely allowed significant improvement permitting surgical resection, and definitive role of postoperative chemotherapy showed no positive impact in Hines et al. (7). No study or report has demonstrated a consistent advantage of chemotherapy for these patients. Brachytherapy is an established method of safely providing adjuvant local radiotherapy used alone or in combination with resection for prostate cancer, breast cancer, cervical cancer and soft tissue sarcomas (8). Compared with external beam irradiation, it spares more normal tissue and permits irradiation of the tumor bed in the immediate postoperative period (9). Brachytherapy options include low dose rate techniques with iridium 192 or iodine 125, fractionated high dose rate brachytherapy, and intraoperative high dose rate therapy. 125 I seeds are characterized by a long half life period and low quantity of radiant energy (10). For certain tumors, consecutive radiotherapy can be performed by implanting 125 I seeds, and the curative effects are better than external radiotherapy. As a kind of brachytherapy, 125 I seeds implantation shows simplicity, safety and effectiveness in the treatment of primary, metastatic and recurrent malignant tumors (10). Brachytheraphy was used to treat primary leiomyosarcoma of the lungs, uterus, rectum and prostate. To the best of our knowledge, no brachytherapy in the treatment of vascular leiomyosarcoma has been reported. We present a rare case of IVC leiomyosarcoma, which protruded mainly to the extravascular space and adjoined aorta, liver, duodenum and kidney. In this case, surgical procedure may be hazardous and life-threatening, which is associated with a high rate of recurrence. EBRT was excluded as it might cause skin injury and radiation enterocolitis. Based on our previous experience with 125 I seeds implantation in malignant soft tissue tumors, brachytherapy and balloon dilatation combined with anticoagulant therapy were applied in this case. Considering the immediate positive results of the procedure, it was decided not to implement an IVC stent. Pre-procedure administration of anticoagulant agent and thrombolytics remarkably decreased the risks of thrombus migration, therefore implantation of retrievable IVC filter was ignored. Chemotherapy was not applied because the patient refused adjuvant treatment. A rare case of primary leiomyosarcoma of the IVC with large intra and extravascular component is presented in this case report. Brachytheraphy is a relatively simple procedure and was applied in this case with excellent results. This success may possibly be attributed in part to the low grade type of the tumor. However, more experience is needed to establish the value of brachytherapy in the treatment of IVC leiomyosarcoma. REFERENCES 1. Dalainas I. Vascular smooth muscle tumors: review of the literature. Int J Surg 2008;6: Ceyhan M, Danaci M, Elmali M, Ozmen Z. Leiomyosarcoma of the inferior vena cava. Diagn Interv Radiol 2007;13: Reddy VP, Vanveldhuizen PJ, Muehlebach GF, Dusing RW, Birkbeck JP, Williamson SK, et al. Leiomyosarcoma of the inferior vena cava: a case report and review of the literature. Cases J 2010;3:71 4. Mingoli A, Sapienza P, Brachini G, Tarantino B, Cirillo B. Surgical treatment of inferior vena cava leiomyosarcoma. J Am Coll Surg 2010;211: Cho SW, Marsh JW, Geller DA, Holtzman M, Zeh H 3rd, Bartlett DL, et al. Surgical management of leiomyosarcoma of the inferior vena cava. J Gastrointest Surg 2008;12: Daylami R, Amiri A, Goldsmith B, Troppmann C, Schneider PD, Khatri VP. Inferior vena cava leiomyosarcoma: is reconstruction necessary after resection? J Am Coll Surg 2010;210: Hines OJ, Nelson S, Quinones-Baldrich WJ, Eilber FR. Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. Cancer 1999;85: Aflatoon K, Manoso MW, Deune EG, Frassica DA, Frassica FJ. Brachytherapy tubes and free tissue transfer after soft tissue sarcoma resection. Clin Orthop Relat Res 2003: Laskar S, Bahl G, Puri A, Agarwal MG, Muckaden M, Patil N, et al. Perioperative interstitial brachytherapy for soft tissue sarcomas: prognostic factors and long-term results of 155 patients. Ann Surg Oncol 2007;14: Ware ML, Larson DA, Sneed PK, Wara WW, McDermott MW. Surgical resection and permanent brachytherapy for recurrent atypical and malignant meningioma. Neurosurgery 2004;54:55-63; discussion Korean J Radiol 14(2), Mar/Apr 2013 kjronline.org
Leiomyosarcoma involving the inferior vena cava in an. elderly patient with reference to its operative modalities: a case report
Leiomyosarcoma involving the inferior vena cava in an elderly patient with reference to its operative modalities: a case report Hiroshi Ushida 1, Ryosuke Murai 1, Mitsuhiro Narita 1, Fumiyoshi Kojima 2
More informationLeiomyosarcoma of the inferior vena cava: 1 case. B. Bancel, A. Rode, C. Ducerf. Hôpital CROIX ROUSSE LYON. Case report
Leiomyosarcoma of the inferior vena cava: 1 case B. Bancel, A. Rode, C. Ducerf Hôpital CROIX ROUSSE LYON Bucharest Nov 2011 Case report 34 yr-old woman, no antecedent Sept 2004: Abdominal upper right quadrant
More informationCase 8 Soft tissue swelling
Case 8 Soft tissue swelling 26-year-old female presented with a swelling on the back of the left knee joint since the last 6 months and chronic pain in the calf and foot since the last 2 months. Pain in
More informationHEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options:
HEPATIC METASTASES 1. Definition Metastasis means the spread of cancer. Cancerous cells can separate from the primary tumor and enter the bloodstream or the lymphatic system (the one that produces, stores,
More informationSolitary Fibrous Tumor of the Kidney with Massive Retroperitoneal Recurrence. A Case Presentation
246) Prague Medical Report / Vol. 113 (2012) No. 3, p. 246 250 Solitary Fibrous Tumor of the Kidney with Massive Retroperitoneal Recurrence. A Case Presentation Sfoungaristos S., Papatheodorou M., Kavouras
More informationIndex. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Ablative therapy, nonsurgical, for pulmonary metastases of soft tissue sarcoma, 279 280 Adipocytic tumors, atypical lipomatous tumor vs. well-differentiated
More informationMultidisciplinary management of retroperitoneal sarcomas
Multidisciplinary management of retroperitoneal sarcomas Eric K. Nakakura, MD UCSF Department of Surgery UCSF Comprehensive Cancer Center San Francisco, CA 7 th Annual Clinical Cancer Update North Lake
More information3D CONFORMATIONAL INTERSTITIAL BRACHYTHERAPY PLANNING FOR SOFT TISSUE SARCOMA
3D CONFORMATIONAL INTERSTITIAL BRACHYTHERAPY PLANNING FOR SOFT TISSUE SARCOMA Alina TĂNASE 1,3, M. DUMITRACHE 2,3, O. FLOREA 1 1 Emergency Central Military Hospital Dr. Carol Davila Bucharest, Romania,
More informationSurgically Discovered Xanthogranulomatous Pyelonephritis Invading Inferior Vena Cava with Coexisting Renal Cell Carcinoma
Case Study TheScientificWorldJOURNAL (2009) 9, 5 9 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2009.6 Surgically Discovered Xanthogranulomatous Pyelonephritis Invading Inferior Vena Cava with Coexisting
More informationBone HDR brachytherapy in a patient with recurrent Ewing s sarcoma of the acetabulum: Alternative to aggressive surgery
Bone HDR brachytherapy in a patient with recurrent Ewing s sarcoma of the acetabulum: Alternative to aggressive surgery Rafael Martínez-Monge 1,* Agata Pérez-Ochoa 1, Mikel San Julián 2, Dámaso Aquerreta
More informationCASE REPORT PLEOMORPHIC LIPOSARCOMA OF PECTORALIS MAJOR MUSCLE IN ELDERLY MAN- CASE REPORT & REVIEW OF LITERATURE.
PLEOMORPHIC LIPOSARCOMA OF PECTORALIS MAJOR MUSCLE IN ELDERLY MAN- CASE REPORT & REVIEW OF LITERATURE. M. Madan 1, K. Nischal 2, Sharan Basavaraj. C. J 3. HOW TO CITE THIS ARTICLE: M. Madan, K. Nischal,
More informationSurgical Management of Retroperitoneal Leiomyosarcoma Arising from the Inferior Vena Cava
J Gastrointest Surg (2013) 17:2166 2171 DOI 10.1007/s11605-013-2385-0 HOW I DO IT Surgical Management of Retroperitoneal Leiomyosarcoma Arising from the Inferior Vena Cava Barbara Zarebczan Dull & Brigitte
More informationBreast Cancer. What is breast cancer?
Scan for mobile link. Breast Cancer Breast cancer is a malignant tumor in or around breast tissue. It usually begins as a lump or calcium deposit that develops from abnormal cell growth. Most breast lumps
More informationRadio-Pathologic Workup of a Retroperitoneal Abdominal Mass
Radio-Pathologic Workup of a Retroperitoneal Abdominal Mass Joe Carlson Advanced Radiology Clerkship Harvard Medical School Year IV September 12, 2002 84 year old Male Presented to PCP With Abdominal Pain
More informationJOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 6, NUMBER 2, SPRING 2005
JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 6, NUMBER 2, SPRING 2005 Advantages of inflatable multichannel endorectal applicator in the neo-adjuvant treatment of patients with locally advanced
More informationBrain Tumors. What is a brain tumor?
Scan for mobile link. Brain Tumors A brain tumor is a collection of abnormal cells that grows in or around the brain. It poses a risk to the healthy brain by either invading or destroying normal brain
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationPavel ŠLAMPA, Jana RUZICKOVA, Barbora ONDROVA, Hana TICHA, Hana DOLEZELOVA
Sole conformal perioperative interstitial brachytherapy of early stage breast carcinoma using high-dose rate afterloading: longer-term results and toxicity Received: 0.09.2007 Accepted: 7.02.2008 Subject:
More informationIntimal angiosarcoma of the thoracic aorta
CASE IN IMAGES 70 OPEN ACCESS Intimal angiosarcoma of the thoracic aorta Michelle Forman, Michael E Mulligan ABSTRACT Introduction: Sarcomas of the great vessels are uncommon, with aortic being the rarest.
More informationMRI Based treatment planning for with focus on prostate cancer. Xinglei Shen, MD Department of Radiation Oncology KUMC
MRI Based treatment planning for with focus on prostate cancer Xinglei Shen, MD Department of Radiation Oncology KUMC Overview How magnetic resonance imaging works (very simple version) Indications for
More informationRecurrent Malignant Fibrous Histiocytoma in Psoas Muscle: A Case Report
Asian Spine Journal Vol. 6, No. 3, pp 211~215, 2012 Malignant Fibrous Histiocytoma in Psoas Muscle / 211 http://dx.doi.org/10.4184/asj.2012.6.3.211 Recurrent Malignant Fibrous Histiocytoma in Psoas Muscle:
More informationBrain Tumor Treatment
Scan for mobile link. Brain Tumor Treatment Brain Tumors Overview A brain tumor is a group of abnormal cells that grows in or around the brain. Tumors can directly destroy healthy brain cells. They can
More informationBreast Cancer Diagnosis, Treatment and Follow-up
Breast Cancer Diagnosis, Treatment and Follow-up What is breast cancer? Each of the body s organs, including the breast, is made up of many types of cells. Normally, healthy cells grow and divide to produce
More informationImaging, it s central role in planning and guiding intervention. Prof. Luis Izquierdo. MD, PhD, FEBVS
Imaging, it s central role in planning and guiding intervention Prof. Luis Izquierdo. MD, PhD, FEBVS IMPORTANT INFORMATION: These materials are intended to describe common clinical considerations and procedural
More informationI-Ming Chen, MD. Endovascular Stenting for Palliative Treatment of Superior Vena Cava Syndrome in End-Stage Lung Cancer
Endovascular Stenting for Palliative Treatment of Superior Vena Cava Syndrome in End-Stage Lung Cancer I-Ming Chen, MD Division of CardioVascular Surgery Taipei Veterans General Hospital, Taiwan (Live
More informationDefinitions. Brachytherapy in treatment of cancer. Implantation Techniques and Methods of Dose Specifications. Importance of Brachytherapy in GYN
Implantation Techniques and Methods of Dose Specifications Brachytherapy Course Lecture V Krishna Reddy, MD, PhD Assistant Professor, Radiation Oncology Brachytherapy in treatment of cancer GYN Cervical
More informationTracheal Adenocarcinoma Treated with Adjuvant Radiation: A Case Report and Literature Review
Published online: May 23, 2013 1662 6575/13/0062 0280$38.00/0 This is an Open Access article licensed under the terms of the Creative Commons Attribution- NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license),
More informationPrimary Synovial Sarcoma of the Kidney: a case report
Chin J Radiol 2004; 29: 359-363 359 Primary Synovial Sarcoma of the Kidney: a case report YU-KUN TSUI 1 CHUNG-JUNG LIN 1 JIA-HWIA WANG 1,4 SHU-HUEI SHEN 1,4 CHIN-CHEN PAN 2,4 YEN-HWA CHANG 3,4 CHENG-YEN
More informationEvaluation of Whole-Field and Split-Field Intensity Modulation Radiation Therapy (IMRT) Techniques in Head and Neck Cancer
1 Charles Poole April Case Study April 30, 2012 Evaluation of Whole-Field and Split-Field Intensity Modulation Radiation Therapy (IMRT) Techniques in Head and Neck Cancer Abstract: Introduction: This study
More informationCorporate Medical Policy
Corporate Medical Policy Intensity-Modulated Radiation Therapy (IMRT) of the Prostate File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_the_prostate
More informationIntrahepatic Sarcomatoid Cholangiocarcinoma with Portal Vein Thrombosis: A Case Report 1
Intrahepatic Sarcomatoid Cholangiocarcinoma with Portal Vein Thrombosis: A Case Report 1 Jae-Hoon Lim, M.D., Jin Woong Kim, M.D., Suk Hee Heo, M.D., Yong Yeon Jeong, M.D., Heoung Keun Kang, M.D. A 53-year-old
More informationAbdominal Exam: The examination of the abdomen used by physicians to detect an abdominal aortic aneurysm.
Glossary of Terms Abdominal Exam: The examination of the abdomen used by physicians to detect an abdominal aortic aneurysm. Angiogram: A diagnostic test requiring the insertion of a catheter into an artery
More informationDevelopment of Myofibrosarcoma after Removal of Longstanding Chemotherapy Port
Case Report Development of Myofibrosarcoma after Removal of Longstanding Chemotherapy Port Christopher P. Rice 1, Aaron Wyble 2, Suimin Qiu 2, Michael Silva 1, Douglas Tyler 1, Linda Phillips 1 and Celia
More informationClinical outcome of leiomyosarcomas of vascular origin: comparison with leiomyosarcomas of other origin
Annals of Oncology 21: 1915 1921, 2010 doi:10.1093/annonc/mdq039 Published online 18 February 2010 Clinical outcome of leiomyosarcomas of vascular origin: comparison with leiomyosarcomas of other origin
More informationBrachytherapy. What is brachytherapy and how is it used?
Scan for mobile link. Brachytherapy Brachytherapy places radioactive sources inside the patient on a temporary or permanent basis to damage cancer cells DNA and destroy their ability to divide and grow.
More informationRare tumors of the heart - angiosarcoma, pericardial lipoma, leiomyosarcoma Three case reports
, pp.178 182 Rare tumors of the heart - angiosarcoma, pericardial lipoma, leiomyosarcoma Three case reports Ioana Stoian, Ileana Tepes Piser, Iulia Kulcsar, O Chioncel, A Carp, C Macarie Prof Dr CC Iliescu
More informationHow ICD-10 Affects Radiation Oncology. Presented by, Lashelle Bolton CPC, COC, CPC-I, CPMA
How ICD-10 Affects Radiation Oncology Presented by, Lashelle Bolton CPC, COC, CPC-I, CPMA ICD-10 ICD-10-CM has added new challenges to the radiation oncology specialty. Approximately 220 ICD-9-CM codes
More informationSubject Index. Androgen antiandrogen therapy, see Hormone ablation therapy, prostate cancer synthesis and metabolism 49
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOO Subject Index Androgen antiandrogen therapy, see Hormone ablation therapy, synthesis and metabolism 49 Bacillus Calmette-Guérin adjunct therapy with transurethral resection
More information2013 Coding Changes. Diagnostic Radiology. Nuclear Medicine
2013 Coding Changes The principal coding changes affecting Radiologists in 2013 occur in the Interventional Radiology Section of the AMA/CPT Manual. As in the past, we continue to see the Relative Update
More informationTrina Lynd, M.S. Medical Physicist Lifefirst Imaging & Oncology Cullman, AL Tri-State Alabama, Louisiana and Mississippi Spring 2016 Meeting April
Trina Lynd, M.S. Medical Physicist Lifefirst Imaging & Oncology Cullman, AL Tri-State Alabama, Louisiana and Mississippi Spring 2016 Meeting April 17, 2016 Discuss permanent prostate brachytherapy and
More informationPercutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related. Iliocaval Thrombosis
Percutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related Iliocaval Thrombosis Faiz D. Francis, DO; Gianvito Salerno, MD; Sabbah D. Butty, MD Abstract In the setting of
More informationProsthetic replacement of the inferior vena cava for malignancy
Prosthetic replacement of the inferior vena cava for malignancy Rajabrata Sarkar, MD, PhD, Frederick R. Eilber, MD, Hugh A. Gelabert, MD, and William J. Quinones-Baldrich, MD, Los Angeles, Calif. Purpose:
More informationCase Report Müllerian Remnant Cyst as a Cause of Acute Abdomen in a Female Patient with Müllerian Agenesis: Radiologic and Pathologic Findings
Volume 2016, Article ID 6581387, 4 pages http://dx.doi.org/10.1155/2016/6581387 Case Report üllerian Remnant Cyst as a Cause of Acute Abdomen in a Female Patient with üllerian Agenesis: Radiologic and
More informationSolitary Contralateral Adrenal Metastases after Nephrectomy for Renal Cell Carcinoma
Original Report ISSN 1537-744X; DOI 10.1100/tsw.2004.39 Solitary Contralateral Adrenal after Nephrectomy for Renal Cell Carcinoma Nikolaos Antoniou, M.D. and Demetrios Karanastasis, M.D. General Hospital
More informationRuolo dell imaging nella pianificazione del trattamento
Simposio AIRO-SIRM: Diagnostica per immagini morfologica e funzionale nella stadiazione, terapia e follow-up dei sarcomi delle parti molli Ruolo dell imaging nella pianificazione del trattamento Marco
More informationBilateral Renal Angiomyolipomas with Invasion of the Renal Vein: A Case Report
Case Study TheScientificWorldJOURNAL (2008) 8, 145 148 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2008.29 Bilateral Renal Angiomyolipomas with Invasion of the Renal Vein: A Case Report C. Blick, N. Ravindranath,
More informationKNIFED IN THE ABDOMEN
Originally Posted: November 01, 2014 KNIFED IN THE ABDOMEN Resident(s): Andrew Duarte, MD Attending(s): Ryan Scott, MD & David Kay, MD Program/Dept(s): St. Joseph s Hospital and Medical Center, Phoenix,
More informationSupplementary Online Content
Supplementary Online Content Mismetti P, Laporte S, Pellerin O, Ennezat P-V, Couturaud F, Elias A, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone
More informationBreast Cancer. What is breast cancer?
Scan for mobile link. Breast Cancer Breast cancer is a malignant tumor in or around breast tissue. It usually begins as a lump or calcium deposit that develops from abnormal cell growth. Most breast lumps
More informationأملس عضلي غرن = Leiomyosarcoma. Leiomyosarcoma 1 / 5
Leiomyosarcoma 1 / 5 EPIDEMIOLOGY Exact incidence is unknown, but older studies suggest that leiomyosarcomas comprise approximately 3 percent of soft-tissue sarcomas. Superficial leiomyosarcoma occurs
More informationFEE RULES RADIATION ONCOLOGY FEE SCHEDULE CONTENTS
Tel: +27-21-9494060 Fax: +27-21-9494112 E-mail: leon.gouws@cancercare.co.za FEE RULES RADIATION ONCOLOGY FEE SCHEDULE CONTENTS 1. EXTERNAL BEAM RADIATION... 2 2. PLANNING OF TREATMENT... 2 3. DELIVERY
More information2012 CPT Changes Affecting Radiology REVISIONS
2012 CPT Changes Affecting Radiology REVISIONS 22520 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic 22521 lumbar 22522
More informationMR Tumor Staging for Treatment Decision in Case of Wilms Tumor
MR Tumor Staging for Treatment Decision in Case of Wilms Tumor G. Schneider, M.D., Ph.D.; P. Fries, M.D. Dept. of Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg/Saar, Germany
More informationDr Claire Smith, Consultant Radiologist St James University Hospital Leeds
Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds Imaging in jaundice and 2ww pathway Image protocol Staging Limitations Pancreatic cancer 1.2.4 Refer people using a suspected
More information3D Conformal Radiation Therapy for Mucinous Carcinoma of the Breast
1 Angela Kempen February Case Study February 22, 2012 3D Conformal Radiation Therapy for Mucinous Carcinoma of the Breast History of Present Illness: JE is a 45 year-old Caucasian female who underwent
More informationCase Report Formation of a Tunnel under the Major Hepatic Vein Mouths during Removal of IVC Tumor Thrombus
Case Reports in Urology Volume 2013, Article ID 129632, 4 pages http://dx.doi.org/10.1155/2013/129632 Case Report Formation of a Tunnel under the Major Hepatic Vein Mouths during Removal of IVC Tumor Thrombus
More informationCONSULTATION DURING SURGERY / NOT A FINAL DIAGNOSIS. FROZEN SECTION DIAGNOSIS: - A. High grade sarcoma. Wait for paraffin sections results.
Pathology Report Date: 3/5/02 A, B. Biopsy right distal femur- high grade spindle cell sarcoma Immunohistochemistry studies are pending to further classify the nature of the tumor. CONSULTATION DURING
More informationREVISITING ICRU VOLUME DEFINITIONS. Eduardo Rosenblatt Vienna, Austria
REVISITING ICRU VOLUME DEFINITIONS Eduardo Rosenblatt Vienna, Austria Objective: To introduce target volumes and organ at risk concepts as defined by ICRU. 3D-CRT is the standard There was a need for a
More informationPROSTATE CANCER BRACHYTHERAPY. Kazi S. Manir MD,DNB,PDCR RMO cum Clinical Tutor Department of Radiotherapy R. G. Kar Medical College
PROSTATE CANCER BRACHYTHERAPY Kazi S. Manir MD,DNB,PDCR RMO cum Clinical Tutor Department of Radiotherapy R. G. Kar Medical College Risk categorization Very Low Risk Low Risk Intermediate Risk High Risk
More informationStaging Colorectal Cancer
Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for
More informationRadiotherapy physics & Equipments
Radiotherapy physics & Equipments RAD 481 Lecture s Title: An Overview of Radiation Therapy for Health Care Professionals Dr. Mohammed Emam Vision :IMC aspires to be a leader in applied medical sciences,
More informationUnusual Osteoblastic Secondary Lesion as Predominant Metastatic Disease Spread in Two Cases of Uterine Leiomyosarcoma
49 Unusual Osteoblastic Secondary Lesion as Predominant Metastatic Disease Spread in Two Cases of Uterine Leiomyosarcoma Loredana Miglietta a Maria Angela Parodi b Luciano Canobbio b Luca Anselmi c a Medical
More informationCase Report Seminoma Presenting as Renal Mass, Inferior Vena Caval Thrombus, and Regressed Testicular Mass
Case Reports in Urology Volume 2015, Article ID 835962, 4 pages http://dx.doi.org/10.1155/2015/835962 Case Report Seminoma Presenting as Renal Mass, Inferior Vena Caval Thrombus, and Regressed Testicular
More informationColorectal Cancer Treatment
Scan for mobile link. Colorectal Cancer Treatment Colorectal cancer overview Colorectal cancer, also called large bowel cancer, is the term used to describe malignant tumors found in the colon and rectum.
More informationBard Meridian Filter Fracture
Bard Meridian Filter Fracture The MIT Faculty has made this article openly available. Please share how this access benefits you. Your story matters. Citation As Published Publisher Wu, Alex et al. Bard
More informationProf. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.
Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,
More informationpitfall Table 1 4 disorientation pitfall pitfall Table 1 Tel:
11 687 692 2002 pitfall 1078 29 17 9 1 2 3 dislocation outflow block 11 1 2 3 9 1 2 3 4 disorientation pitfall 11 687 692 2002 Tel: 075-751-3606 606-8507 54 2001 8 27 2002 10 31 29 4 pitfall 16 1078 Table
More informationSectional Anatomy Quiz - III
Sectional Anatomy - III Rashid Hashmi * Rural Clinical School, University of New South Wales (UNSW), Wagga Wagga, NSW, Australia A R T I C L E I N F O Article type: Article history: Received: 30 Jun 2018
More informationINTRACAVITARY BALLOON BRACHYTHERAPY FOR MALIGNANT AND METASTATIC BRAIN TUMORS
METASTATIC BRAIN TUMORS Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and
More informationUNMH Radiology Clinical Privileges. Name: Effective Dates: From To
All new applicants must meet the following requirements as approved by the UNMH Board of Trustees, effective April 28, 2017: Initial Privileges (initial appointment) Renewal of Privileges (reappointment)
More information20 Prostate Cancer Dan Ash
20 Prostate Cancer Dan Ash 1 Introduction Prostate cancer is a disease of ageing men for which the aetiology remains unknown. The incidence rises up to 30 to 40% in men over 80. The symptoms of localised
More informationCertification Review. Module 28. Medical Coding. Radiology
Module 28 is the study of x-rays, using radiant energy and other imaging techniques, such as resonance imaging or ultrasound, to diagnose illnesses and diseases. Vocabulary Barium enema (BE): lower gastrointestinal
More informationIMRT - the physician s eye-view. Cinzia Iotti Department of Radiation Oncology S.Maria Nuova Hospital Reggio Emilia
IMRT - the physician s eye-view Cinzia Iotti Department of Radiation Oncology S.Maria Nuova Hospital Reggio Emilia The goals of cancer therapy Local control Survival Functional status Quality of life Causes
More informationRenal vascular evaluation with 64 Multislice Computerized Tomography Daniela Stoisa, Fabrizzio E. Galiano, Andrés Quaranta, Roberto L.
Renal vascular evaluation with 64 Multislice Computerized Tomography Daniela Stoisa, Fabrizzio E. Galiano, Andrés Quaranta, Roberto L. Villavicencio Footnote Diagnóstico Médico Oroño. Bv. Oroño 1515. 2000.
More informationProstate Cancer Treatment
Scan for mobile link. Prostate Cancer Treatment Prostate cancer overview Prostate cancer is the most common form of cancer in American men, most prevalent in men over age 65 and fairly common in men 50-64
More informationEndovascular treatment of acquired arteriovenous fistula with severe hemodynamic effects: a case report
Endovascular treatment of acquired arteriovenous fistula with severe hemodynamic effects: a case report The Leipzig Interventional Course, January 24 27, 2017 El Samman K., Šedivý P., Šnajdrová A., Přindišová
More informationVascular Imaging in the Pediatric Abdomen. Jonathan Swanson, MD
Vascular Imaging in the Pediatric Abdomen Jonathan Swanson, MD Goals and Objectives To understand the imaging approach, appearance, and clinical manifestations of the common pediatric abdominal vascular
More informationASSESSING THE PLAIN ABDOMINAL RADIOGRAPH M A A M E F O S U A A M P O F O
ASSESSING THE PLAIN ABDOMINAL RADIOGRAPH M A A M E F O S U A A M P O F O Introduction The abdomen (less formally called the belly, stomach, is that part of the body between the thorax (chest) and pelvis,
More informationSample page. POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.
2018 Complete Guide for Interventional Radiology An in-depth guide to interventional radiology coding, billing, and reimbursement for facilities and physicians POWER UP YOUR CODING with Optum360, your
More informationCase Scenario 1. Discharge Summary
Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal
More informationСтенты «Ella-cs» Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts»
Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts» A. Esophageal Stenting and related topics 1 AMJG 2009; 104:1329 1330 Letters to Editor Early Tracheal Stenosis Post Esophageal Stent
More informationCorporate Medical Policy
Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Abdomen and File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis
More informationPEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING
PEDIATRIC ORBITAL TUMORS RADIOTHERAPY PLANNING ANATOMY ANATOMY CONT ANATOMY CONT. ANATOMY CONT. EYE OF A CHILD Normal tissue tolerance doses (in conventional #) TD 5/5 TD 50/5 Endpoint Gy Gy Optic nerve
More informationOutline - MRI - CT - US. - Combinations of imaging modalities for treatment planning
Imaging Outline - MRI - CT - US - Combinations of imaging modalities for treatment planning Imaging Part 1: MRI MRI for cervical cancer high soft tissue contrast multiplanar imaging MRI anatomy: the normal
More informationAnomalies of the inferior vena cava
Anomalies of the inferior vena cava Joseph M. Giordano, M.D., and Hugh H. Trout III, M.D., Washington, D.C. The inferior vena cava is formed by a complex process of embryogenesis during the sixth to tenth
More informationMalignant related superior vena cava (SVC) syndrome
Malignant related superior vena cava (SVC) syndrome Manit Sae-teaw B.Pharm, BCP, BCOP Grad dip in Pharmacotherapy Faculty of pharmaceutical sciences Ubon Ratchathani University 1 Outline Introduction Etiology
More informationANNEX 1 OBJECTIVES. At the completion of the training period, the fellow should be able to:
1 ANNEX 1 OBJECTIVES At the completion of the training period, the fellow should be able to: 1. Breast Surgery Evaluate and manage common benign and malignant breast conditions. Assess the indications
More informationCase 37 Clinical Presentation
Case 37 73 Clinical Presentation The patient is a 62-year-old woman with gastrointestinal (GI) bleeding. 74 RadCases Interventional Radiology Imaging Findings () Image from a selective digital subtraction
More informationDOSIMETRIC OPTIONS AND POSSIBILITIES OF PROSTATE LDR BRACHYTHERAPY WITH PERMANENT I-125 IMPLANTS
DOSIMETRIC OPTIONS AND POSSIBILITIES OF PROSTATE LDR BRACHYTHERAPY WITH PERMANENT I-125 IMPLANTS Andrius IVANAUSKAS*, Eduardas ALEKNAVIČIUS*, Arvydas BURNECKIS*, Albert MILLER *Institute of Oncology Vilnius
More informationINTRAUTERINE DEVICE = IUD INTRAUTERINE DEVICE = IUD CONGENITAL DISORDERS Pyometra = pyometrea is a uterine infection, it is accumulation of purulent material in the uterine cavity. Ultrasound is usually
More informationDefining Target Volumes and Organs at Risk: a common language
Defining Target Volumes and Organs at Risk: a common language Eduardo Rosenblatt Section Head Applied Radiation Biology and Radiotherapy (ARBR) Section Division of Human Health IAEA Objective: To introduce
More informationMRI in Cervix and Endometrial Cancer
28th Congress of the Hungarian Society of Radiologists RCR Session Budapest June 2016 MRI in Cervix and Endometrial Cancer DrSarah Swift St James s University Hospital Leeds, UK Objectives Cervix and endometrial
More informationThe value of MSCT in diagnosis of intravenous leiomyomatosis
The value of MSCT in diagnosis of intravenous leiomyomatosis Poster No.: C-0060 Congress: ECR 2012 Type: Scientific Exhibit Authors: C. Sun, Z.-D. Xv, W. Xi-ming, C. Liu; Jinan/CN Keywords: Volvulus, Cardiac
More informationCase Report A Case of Pulmonary Sarcoma with Significant Extension into the Right Lung
Case Reports in Medicine, Article ID 279374, 4 pages http://dx.doi.org/10.1155/2014/279374 Case Report A Case of Pulmonary Sarcoma with Significant Extension into the Right Lung Yoshiaki Inoue, 1 Yotaro
More informationBRACHYTHERAPY FOR TREATMENT OF MISCELLANEOUS CANCERS
BRACHYTHERAPY FOR TREATMENT OF MISCELLANEOUS CANCERS Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan.
More informationSETTING Fudan University Shanghai Cancer Center. RESPONSIBLE PARTY Haiquan Chen MD.
OFFICIAL TITLE A Phase Ⅲ Study of Left Side Thoracotomy Approach (SweetProcedure) Versus Right Side Thoracotomy Plus Midline Laparotomy Approach (Ivor-Lewis Procedure) Esophagectomy in Middle or Lower
More informationCervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix.
Cervical Cancer Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where
More informationCase Presentation. Gordon Callender M.D. Surgical Resident
Case Presentation Gordon Callender M.D. Surgical Resident Retroperitoneal Sarcomas Sarcomas Heterogeneous group of rare tumors that arise predominantly from the embryonic mesoderm. Expected incidence for
More informationGene Expression Profiling has been proposed as a method of risk stratification for uveal melanoma.
Last Review Status/Date: September 2014 Description Page: 1 of 5 Gene Expression Profiling has been proposed as a method of risk stratification for uveal melanoma. Background Uveal melanoma Uveal melanoma,
More information